Provider Demographics
NPI:1477809457
Name:HOPE WITHIN WELLNESS CENTER LLC
Entity Type:Organization
Organization Name:HOPE WITHIN WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO- OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LEA
Authorized Official - Middle Name:RM
Authorized Official - Last Name:THIBEAULT
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:570-497-4766
Mailing Address - Street 1:305 S CHURCH ST
Mailing Address - Street 2:SUITE 115
Mailing Address - City:HAZLETON
Mailing Address - State:PA
Mailing Address - Zip Code:18201-7605
Mailing Address - Country:US
Mailing Address - Phone:570-497-4766
Mailing Address - Fax:570-245-3899
Practice Address - Street 1:305 S CHURCH ST
Practice Address - Street 2:SUITE 115
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-7605
Practice Address - Country:US
Practice Address - Phone:570-497-4766
Practice Address - Fax:570-245-3899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-27
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADC005879L111N00000X
PAMSG003571225700000X
PAMSG003195225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Single Specialty